Provider Demographics
NPI:1831351055
Name:TANNA, MONICA SHARMA (DDS)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:SHARMA
Last Name:TANNA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 ALDERSHOT LN
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3716
Mailing Address - Country:US
Mailing Address - Phone:443-783-5673
Mailing Address - Fax:
Practice Address - Street 1:450 PLANDOME RD STE 102
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1937
Practice Address - Country:US
Practice Address - Phone:516-627-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-29
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA581741223P0221X
NY055400-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03396054Medicaid